Extensive multiple and lobe-sparing pulmonary resections with the Nd: YAG laser and a new wavelength of 1318 nm.

AIMS

Analysing the results of extensive parenchymal resections in 110 patients we want to demonstrate the safe usage and the superiority of the second Nd: YAG laser wavelength (1318 nm) which shows significantly better lung tissue determinants.

METHODS

Between 3/96 and 11/97, 110 patients (66 men and 44 women, mean age 60 years) were integrated prospectively in three groups and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength. 78 patients had suspected lung metastases of known primary malignancies (group 1); 20 patients with poor lung function had peripheral T1 or T2 lung primaries (group 2) and 12 patients had multiple pulmonary nodules but unknown malignancies (group 3).

RESULTS

In group 1 we resected 353 nodules or 4.6 nodules per patient, between 5 and 60 nm. Although 41% of all lesions were deep-seated and only 28% solitary, it was in 97.5% possible to perform precision resections. In two patients (2.5%) lobectomy was necessary which demonstrates a drastic decrease of the lobectomy rate--reported between 20 and 30% in the literature. There was no mortality in all groups, and only two complications were treated conservatively.

DISCUSSION

The technical improvements in this special laser (1318 nm) allow extensive parenchymal resections and should make the long-discussed advantages of lasers in open lung surgery applicable to a broad clinical usage.